Enalapril and breastfeeding

[LucyBKI]

Hi, hoping someone can help with my worries tonight.

I had preeclampsia and had to have an EMCS at 38 weeks after my BP was through the roof and protein in my urine. DS was delivered safely but it’s been a real struggle to get my BP under control in the first couple of weeks. I was sent home from hospital the next day but then midwife came out and sent me straight back in with raised BP and I stayed in for five days.

I was initially on Labetalol but kept having really bad side effects to the point one night in hospital I had the worst migraine of my life where it felt like someone had my brain in a vice grip. They switched me to Nifedipine and Enalapril (5g).

This was prescribed in the hospital where they knew I was breastfeeding and then I also discussed my medications with my GP. At no point did anyone say about the problems with breastfeeding and taking Enalapril. I’ve just been reading about it tonight and read it shouldn’t be taken in the first few weeks of a newborns’ life, I’ve been taking it since day 3 to now day 26.

My BP is normal and steady so the GP took me off Enalapril today and just taking the Nifedipine and I’ve got to monitor my BP for a week. However, I’m stressing that I’ve harmed my DS by taking it while breastfeeding! Typically it’s bank holiday so can’t speak to the doctor until Tuesday.

He’s generally been quite a sleepy baby in a sense we don’t have a lot of awake time and he’s had slow weight gain so now I’m worried it’s connected. I started taking Enalapril at night recently and have switched a night feed out with a bottle and he has been a little more alert recently so I’m thinking that it might have started clearing my milk by the time he’s next feeding?

Sorry for the long message. Can anyone offer and reassurance or advice?

https://www.sps.nhs.uk/articles/using-ace-inhibitors-during-breastfeeding/#:~:text=Limited%20evidence%20shows%20that%20enalapril,10mg%20daily%20for%2011%20months.

hope this makes things a bit clearer

I'll summarise what I have found on the drugs in breastfeeding database "Lactmed" which summarises the available research on drugs in breastfeeding.

In mothers breastfeeding whilst taking enalapril 5mg or 10mg, the highest peak level found in breastmilk was only 2 micrograms/L (1/5000th the 10mg dose if the baby drank a full litre of milk at it's peak concentration). And in other mothers it was never detectable in breastmilk. So it seems enalapril does not reach breastmilk in significant quantities. The estimate is that a fully breastfed infant could receive no more than 2 micrograms in a day. This is a safe / insignificant dose for a medication that is actually used in newborn infants (the dose used in newborn babies who need enalapril would be 10micrograms/kg, so around 30-40 micrograms).

No adverse effects have ever been observed in the infants of breastfeeding mothers taking enalapril.

So personally - I would feel completely safe taking this medication and breastfeeding and I would not advise a mother who needs this medication to stop taking it because she is breastfeeding or to stop breastfeeding because she is taking it. In as far as we know, it is very safe and there are lots of women who take this medication postpartum whilst breastfeeding.

There is some evidence it could reduce prolactin levels which might reduce/inhibit milk production but no case studies of this actually occuring.

I hope you find this reassuring. In any case enalapril does not produce any sedating affects so any change in your baby's behaviour must be a coincidence. Keep up the good work! Xxx